Ohio Administrative Code
Title 5505 - State Highway Patrol Retirement System
Chapter 5505-7 - Benefits
Section 5505-7-11 - Dental and vision coverage
Universal Citation: OH Admin Code 5505-7-11
Current through all regulations passed and filed through September 16, 2024
(A) For the purpose of this rule:
(1)
"Age and service retirant" shall mean a former member
that applied for and was granted retirement benefits as described in section
5505.16 of the Revised
Code.
(2)
"Benefit recipient" shall mean an age and service
retirant or disability retirant that is receiving a pension benefit as
described in division (A)(1) of section
5505.17 of the Revised Code that
qualifies for health care coverage pursuant to paragraph (D) of rule 5505-7-04
of the Administrative Code. Benefit recipient does not include a member
participating in the "Deferred Retirement Option Plan."
(3)
"Child" shall
mean a biological child, lawfully adopted child, child placed for adoption or
stepchild of a benefit recipient or member provided that such child has not yet
attained age twenty-six. "Child" shall also mean a child for whom a benefit
recipient or member has been legally appointed as guardian, provided that such
child has not yet attained age eighteen.
(4)
"Dependent" shall
mean a spouse or child as defined in this rule.
(5)
"Disability
retirant" shall mean a former member that applied for and was granted
retirement benefits as described in section
5505.18 of the Revised
Code.
(6)
"Member" shall have the same meaning as division (I) of
section 5505.01 of the Revised
Code.
(7)
"Retirant" shall mean an age and service retirant or
disability retirant.
(8)
"Spouse" shall mean a wife or husband of a retirant or
member as set forth in a statutorily valid certificate.
(B)
(1)
Except as
provided in paragraph (B)(2) of this rule, the state highway patrol retirement
system may offer dental or vision coverage that is administered by a
third-party administrator(s) to benefit recipients and dependents provided that
the benefit exceeds the premium set by the board for coverage under this
rule.
(2)
A spouse of a benefit recipient shall cease to be
eligible for coverage on the first day of the month following the date of the
final decree of divorce or dissolution from the benefit
recipient.
(C) Enrollment
(1)
Except as provided in paragraph (C)(2) of this rule, a
benefit recipient's application for dental or vision coverage must be received
by the retirement system not later than sixty days after the benefit
recipient's eligibility of retirement benefits, as defined in rule
5505-3-01 of the Administrative
Code.
(2)
A benefit recipient that does not enroll as provided in
paragraph (C)(1) of this rule may enroll by filing an application for
enrollment in dental or vision coverage during one of the following:
(a)
The annual open
enrollment period:
(b)
Within sixty days of involuntary termination of
coverage under another group plan, and with proof of such
termination.
(3)
A benefit recipient may enroll a dependent in coverage
during the annual open enrollment period or at any time outside of open
enrollment if any of the following apply and the application is received not
later than sixty days after the occurence of the event:
(a)
The benefit
recipient may enroll a new spouse upon marriage;
(b)
The benefit
recipient may enroll an eligible child upon the birth or adoption of the
child;
(c)
The benefit recipient may enroll an eligible dependent
who has involuntarily lost vision and dental coverage from another
source;
(d)
The benefit recipient is ordered to enroll a child
pursuant to a national medical support order;
(e)
The dependent
first achieves an eligibility threshold as described in this
rule.
(4)
Enrollment of a benefit recipient or eligible dependent
under this rule shall be made on an application provided by the retirement
system.
(D) After the death of a retirant or member, dependents are eligible or become eligible for dental and vision coverage if the retirant or member was eligible to be a benefit recipient at the time of death.
(E) Effective date of coverage
(1)
The effective
date of coverage of a benefit recipient or eligible dependent shall be the
first day of the month following the system's receipt of the benefit
recipient's application, provided enrollment is valid under this
rule.
(2)
Notwithstanding paragraph (E)(1) of this rule, in the
case of enrollment during open enrollment, the effective date of coverage shall
be January first of the following year.
(F) The following provisions apply to the dental and vision coverage offered by the retirement system:
(1)
The
coverage shall be in effect for a calendar year.
(2)
An individual
enrolled in coverage may voluntarily terminate the individual's enrollment in
the coverage or a dependent's enrollment in the coverage only at the end of
each calendar year by filing the notice of cancellation in a form and manner
approved by the retirement system during the open enrollment
period.
(3)
Notwithstanding paragraphs (F)(1) and (F)(2) of this
rule, an individual enrolled in coverage may voluntarily terminate the
individual's enrollment in the coverage by submitting proof to the retirement
system that the individual has obtained other coverage through an employer or a
spouse's employer.
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